Virginia Premier will cover the full cost, waiving any co-pays or cost sharing for coronavirus (COVID-19) diagnostic testing.
Criteria for Testing:
Testing for the coronavirus (COVID-19) requires a Provider requisition and the specimen must be collected in a physician office, clinic or hospital to be valid.
- Visit the Virginia Department of Health for guidelines for coronavirus (COVID-19) testing http://www.vdh.virginia.gov/coronavirus/health-professionals/vdh-updated-guidance-on-testing-for-covid-19/
- Visit the CDC for updated guidelines for coronavirus (COVID-19) testing guidelines:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
Laboratories and Requirements:
Providers should confirm whether hospitals have the technology to render a coronavirus (COVID-19) test. Here are laboratories that can conduct the test as needed:
- Department of Consolidated Laboratory Services: https://dgs.virginia.gov/division-of-consolidated-laboratory-services/updates/hot-topics/
- LabCorp: https://www.labcorp.com/coronavirus-disease-covid-19
- Quest Diagnostic: https://www.questdiagnostics.com/home/Covid-19/
Billing and Claims for Testing Services:
Health Plan | Prior Authorization Required? | COVID-19 HCPCS Code | Coverage | Effective Dates |
|---|---|---|---|---|
Medicaid/ Medicare/ Individual and Family | No | U0001 For SARS-CoV-2 (CDC testing laboratories) | Yes | On or after March 12 |
Medicaid/ Medicare/ Individual and Family | No | U0002 for SARS-Cov (non-CDC laboratories) | Yes | On or after March 12 |
Medicare Advantage/ Individual and Family | No | U0003, SARS-CoV-2 (high throughput technologies) | Yes | On April 14, 2020 |
Medicare Advantage/ Individual and Family | No | U0004, SARS-CoV-2 (high throughput technologies) | Yes | On April 14, 2020 |
Medicare Advantage/ Individual and Family | No |
G2023, SARS-CoV-2 (specimen collection) | Yes | On March 1, 2020 |
Medicare Advantage/ Individual and Family | No | G2024, SARS-CoV-2 (specimen collection, SNF/Home Health) | Yes | On March 1, 2020 |
Medicare Advantage/ Individual and Family | No | 86318, (antibody, qualitative or semiquantitative, single step) | Yes | On April 10, 2020 |
Medicare Advantage/ Individual and Family | No | 86328, SARS-CoV-2 (antibody testing, single step) | Yes | On April 10, 2020 |
Medicare Advantage/ Individual and Family | Yes | 86769, SARS-CoV-2 (antibody testing, multi-step) | Yes | On August 10, 2020 |
Medicare Advantage/ Individual and Family | Yes | 87635, SARS-CoV-2 (amplified probe technique) | Yes | On August 10, 2020 |
